Archive for 2006

The Dossia Initiative in PHRs

December 6, 2006

Announced today was as employer coalition to enable personal health records to be aggregated from different sources. This initiative managed by a non-profit called Omnimedix has an invitation to join on the Dossia website. The reports indicate a full release in mid-2007. Other companies are working on similar initiatives.

Will this be a first to market win or more dependent on major partnerships and ease of use? Wait and see.

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Consumer attitudes toward PHR, EHR

December 6, 2006

In a new study release by Price, Waterhouse, Coopers, Top Seven Health Care Trends in ’07, there an indication of low confidence that EHRs will improve care (34% yes) but a larger group who are undecided or need more information (42%). I don’t agree with the report title in Healthcare IT News which says, “Consumers don’t believe EHRs will improve care, report says”. I think the lesson from the report is the need more information. The failure here is not communicating the importance of EHRs and PHRs and the value they provide to the consumer.
Also in the report is the trends toward “Consumers taking the wheel” (consumer driven health plans success will depend on word of mouth reports) and “Private equity investors will fund the next generation of innovation in services and treatments, challenging larger competitors that lack market agility.” This will be true not only in minute clinics but other new practice venues.

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New York Times on Privacy and EHRs

December 4, 2006

In the December 3rd edition of the New York Times, a story titled “Health Hazard: Computers Spilling Your History” examines privacy of electronic medical records. In addition to finding how hospitals can successfully defeat attempts of employees to sneak a peak at medical records of the rich and famous (including President Clinton), the author cites concerns in Congress, e.g., “But the toughest challenge may be a human one: acute public concern about security breaches and identity theft.” This is cited as the major barrier to adoption of EMRs by physicians in the U.S. while other western countries have up to 89% use. One observation of a policy analyst: “If you don’t have the trust of patients, they will withhold information and won’t take advantage of the new system.”

Well said, but much of the task of protecting privacy is proper planning and implementation of systems. One of the biggest threats appears to be health care workers who store patient data on laptops. With all the methods of securing laptops or better yet, accessing centralized systems through secure channels, why should this continue to be a risk.

One note on PHRs: “EVEN without new federal laws to guide them, some companies have begun
to encourage their employees to embrace electronic medical records. At Pitney Bowes, employees are paid a bonus if they store a copy of their personal health records on WebMD.com, the medical Web site.” An encouraging sign and a new way to use incentives.

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Diagnosis Google Style

November 27, 2006

Lots of buzz on the British Medical Journal article on Googling for a diagnosis–use of Google as a diagnostic aid: internet based study. The study showed “Google searches revealed the correct diagnosis in 15 (58%).

The comments on the BMJ website related to this article are equally interesting: “Pubmedding is better than googling” and Google Medicine – proceed with caution and this quote: “Google’s accuracy of 58%, reported by Tang and Ng, is less than that achieved by older generation rules based Diagnosis Decision Support System [3] and will not engender widespread adoption.” In fact, would you be confident of this kind of percentage.

Perhaps a more realistic test would be to give two physican panels test cases and two different tools sets – a decision support tool like Micromedix and the other just Google and see how accurate they become.

At any rate, the article provokes more discussion and research.

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Trivergence

November 25, 2006

On Future HIT, I found a post about trivegence. Trivergence is a new concept defined by Accenture as the meeting of devices, controls and data. They argue that because architecture now supports multiple devices, that the integration of controls and data into devices now enables unique opportunities. While convergence refers to “the unification of voice, data and video on the network level”,  “Trivergence is an architecture that brings a new organization to devices, networks and controls. The conceptual breakthrough is that if a device is on the network, its controls can be located somewhere other than on the device itself. As a result, devices that used to be stand-alone entities are now cogs within a much larger system—a system that enables new user experiences through the interaction of its components.”

What about trivergence in healthcare? Certainly as more devices in clinical settings become connected to networks, the implications can be huge. Perhaps the greatest implications will be in telemedicine.

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Health Care 2.0 – Home Monitoring

October 13, 2006

CNN reports on Wednesday how home monitoring can significantly impact medical costs. The give examples of home dialysis and Health Buddy and note in the latter that adult children can use it to monitor their elderly parents. Health 3.0 as the next generation include genetic testing services, retail therapy/clinics, second opinion for medical bills and more entrepreneurs like Steve Case and his Revolution Health.

While the mimicking of Web 2.0 can get old, certainly home treatment and monitoring and new health delivery models are becoming more prevalent. However, it is hard to predict the adoption rate of these new services – much will depend on reimbursement/business models and the consumer’s trust in these delivery systems.

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Assessing the impact of eHealth – a European Perspective

October 13, 2006

In an article on the eHealth News blog, the authors cite a report called eHealth Impact, which showed significant return on investment for eHealth projects. The authors interpret this with some caution, however. “During the research, the team discovered that ineffective eHealth services are often caused by poor service implementation. They

therefore analysed the ten evaluated sites to identify lessons to be learned for successful implementation of effective eHealth solutions.” The eHealth Impact project ” focused on the three stages in the lifecycle of eHealth investments – planning and development, implementation, and routine operation. The project team developed a set of tools to collect relevant information on each stage.” They note that it is difficult to create a standardized way of studying economic impact when the eHealth projects are so diverse. A big factor is stakeholders: “The more stakeholders and the earlier they are brought in, the greater the chances of success.”

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eVisits to Be Covered by Some Insurors

October 9, 2006

An article from Minneapolis indicates that two insurance companies in Minnesota are planning to cover evisits. This means a $35 fee for each email to a patient. The article notes that physicians have been slow to adopt (in some cases complete avoid) email as a form of communication with patients due to lack of reimbursement. The Minnesota experience shows a slow rate of adopting (100 patients in 5 months for HealthPartners) which is similar to the gradual adoption rates of personal health records. Patients who are early adopters or those with chronic illness and significant travel time may be the initial users in this technology especially in areas where internet usage and higher bandwidth is still growing. But many parents and family caregivers are using the internet at home and work and will begin to adopt this if they get a timely response from the physician.

The article did not discuss secure email or how users may feel about privacy.

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eHealth Progress

October 6, 2006

In an editorial by Henry Potts of London, he raises the question, “Is E-health Progressing Faster Than E-health Researchers?” Some of the quotable answer includes: “Traditional healthcare, given its safety critical context, utilises an evidence base and a process of risk management that generally involves some sort of governance. These are conflicting trends: the great value of the Internet is how easy it is to make material available, but the strictures of safety and proof of efficacy run counter to that. How do we garner the benefits of the Internet – the democratization of production and distribution that has produced so much content – while maintaining safe and good practice?”

And in an acknowledgment to social networking, “Beyond healthcare, there are many more innovations that draw on user-generated content and the Internet’s democratization of production and distribution. The “killer application” in e-health will perhaps be something that can marry the democratized nature of MySpace or Wikipedia with the safety critical nature of healthcare.”

These conflicting values of control and freedom are particularly acute in web-based consumer directed healthcare. Web 2.0 values need a way to take root within healthcare.

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Are Physicians Ready for Patients With Internet-Based Health Information?

October 3, 2006

This article appearing in the Journal of Medical Internet Research by a Canadian group of authors is a study looking at how physicians deal with a common phenomenon of the Internet Age: patients bringing Internet health information to their appointments.Themes include: “(1) perceived reactions of patients, (2) physician burden, and (3) physician interpretation and contextualization of information.” Generally, physicians found this information problematic and enough of it misinformation that it could cause distress and confusion.

Four conclusions:

  1. physician awareness leading to acceptance of this information in the exam room as the norm
  2. physician training in redirecting patients to recommended web resources
  3. rewarding the time-pressed physician for competence in information technology (incentives)
  4. patient education on how to search for information and the appropriate use of that information within patient-physician communication.

The need for strategies to address this challenge in physician-patient communication is essential. Prescribing health information is one tested approach. By physician approaches need testing as well.

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